Wellness & Weight Management Program

Admission to the program will include a comprehensive assessment of the following:

• Weight and weight history including calculating body mass index, assessing history of weight gain and loss including factors associated with weight gain and methods of successful weight loss, weight-related conditions, and medications that may affect body weight.
• Usual frequency and content of meals and snacks particularly eating habits to which weight gain may be attributed.
• Eating pathology: Present and historical symptoms of binge eating, night eating, and bulimia nervosa.
• Environmental assets and obstacles: Supportive and disruptive influences within SJVC and at home.
• The pastoral and spiritual realties correlated to this condition.
• General psychopathology and psychological resources.

Assessment data will be obtained through the following sources:

• Psychiatric Evaluation
• Psychological Evaluation
• Pastoral and Spiritual Evaluation
• Clinical interview
• Weight and Lifestyle Inventory
• Beck Depression Inventory-II
• Millon Behavioral Medicine Diagnostic
• Record Review
• Consultation with SJVC treatment providers

Based upon assessment data and patient preferences, a course of treatment will be recommended. Most interested patients will progress to the Lifestyle Modification program while some individuals will be referred for medical or surgical intervention as an adjunct to lifestyle modification.

Group sessions. A rotation of 22 group sessions based upon treatment materials from research and outcome supported weight loss studies will be implemented. Sessions will be conducted in a classroom-type setting and will include a mix of lecture, interactive discussion, and question-and-answer. Sessions will fall into one of three broad areas:

• Nutrition – Nine of the group meetings will focus on nutrition. Nutrition guidelines, calorie-density, good-vs.-bad fats and carbohydrates, use of meal replacements, and meal planning are examples of topics that will be covered.
• Behavior change – A number of cognitive and behavioral skills will be taught, including identifying and modifying environmental cues to eat, seeking social support, problem-solving, and challenging negative thoughts. Eight group meetings will cover a behavior change topic.
• Physical activity – The remaining five group sessions will cover topics related to increasing physical activity. These may include resistance training, aerobic exercise, and lifestyle activity.

Group activities. In addition to the classroom-type sessions described above, there will be group activities scheduled every two weeks in which patients apply material or practice skills learned in sessions. Some examples are the following: group walks, supervised exercise sessions, cooking demonstrations/classes, grocery store trips (e.g., to identify ingredients consistent with a low-calorie diet), cafeteria "tests" (e.g., to assemble meals that reach specified calorie/nutrient guidelines), relaxation training (e.g., progressive muscle relaxation), and psycho-spiritual groups (how can one's spirituality aid or obstruct progress?).

Individual sessions. Twice per week, each patient will meet individually with the counselor to review progress in the program, discuss obstacles that have been encountered, plan for anticipated obstacles, and set new goals.

The Wellness Education and Diet Modification program is designed for individuals who are ready to manage a typical diet or those who are progressing from the meal replacement tier. The program will consist primarily of group sessions but will also include individual sessions. The groups are designed to be open allowing new admissions to join ongoing groups. However, because some preliminary skills and prerequisite material will be necessary to fully benefit from the groups, new admissions will have two individual introductory sessions before joining an existing group. Weight will be recorded at every contact. In addition, the milieu will include an environment conducive to weight management and wellness including a dining area that offers:

• Signage that not only gives calorie content of all prepared items, but also depicts the serving size on which the provided nutrition information is based.
• Smaller serving utensils and plates.
• An entrée and dessert item designated as health-conscious by meeting nutritional guidelines for calories, fat, and sodium.
• Displays showing various combinations of items that provide approximately 400 and 500 calories for lunch and dinner, respectively.
• Availability of fresh fruits and vegetables and low-calorie beverages

Group sessions. A rotation of group sessions based upon treatment materials from research and outcome supported weight loss studies will be implemented. Sessions will be conducted in a classroom-type setting and will include a mix of lecture, interactive discussion, and question-and-answer. Sessions will fall into one of three broad areas:

• Nutrition – Nutrition guidelines, calorie-density, good vs. bad fats and carbohydrates, use of meal replacements, and meal planning are examples of topics that will be covered.
• Behavior change – A number of cognitive and behavioral skills will be taught, including identifying and modifying environmental cues to eat, seeking social support, problem-solving, and challenging negative thoughts.
• Physical activity – Other group sessions will cover topics related to increasing physical activity. These may include resistance training, aerobic exercise, and lifestyle activity.

Group activities. In addition to the classroom-type sessions described above, there will be group activities scheduled every week in which patients apply material or practice skills learned in sessions. Some examples are the following: group walks, supervised exercise sessions, cooking demonstrations/classes, grocery store trips (e.g., to identify ingredients consistent with a low-calorie diet), cafeteria "tests" (e.g., to assemble meals that reach specified calorie/nutrient guidelines), relaxation training (e.g., progressive muscle relaxation), and psycho-spiritual groups (how can one's spirituality aid or obstruct progress?).

Individual sessions. Twice per week, each patient will meet individually with the counselor to review progress in the program, discuss obstacles that have been encountered, plan for anticipated obstacles, and set new goals.

Participants with a body mass index over 40 kg/m2 or (35 kg/m2 with serious weight-related co-morbidities) may be eligible for bariatric surgery. The most common surgical procedures, gastric bypass and adjustable gastric banding, will be presented to seemingly eligible participants during the initial assessment. Interested individuals will be referred for a consultation with a bariatric surgery team.

Pre-operative preparation and post-operative follow-up. Patients seeking bariatric surgery will remain enrolled in the Lifestyle Modification program. The dietary recommendations and behavioral skills taught in that program will be tailored to mimic the post-operative diet of solid foods. The Lifestyle Modification program's individual sessions will focus on practicing the skills necessary for post-operative compliance and on anticipating and coping with the positive and negative emotional consequences of bariatric surgery. Psychological services will be available for post-operative adjustment.

Lifestyle Maintenance. Because it is important to sustain changes in diet and activity, two types of maintenance programs are offered.

Ongoing Maintenance Sessions. After completing any tier, patients who remain at SJVC will be encouraged to continue their work through Lifestyle Maintenance. Patients will be encouraged to maintain at least one contact per week. Whether that contact is in a group session, group activity, or individual session will be determined collaboratively by the patient and counselor.